The sound you hear in your ear/ears in the absence of an external stimulus is called Tinnitus. It is often called “ringing in your ears”. You may hear sounds like that of hissing, whistling, ticking, buzzing, roaring, or clicking and the sound can be temporary or persistent (continuous).  

Tinnitus is basically a sound that you hear that no one else does and this is why it is also called  ‘Subjective Tinnitus’. Tinnitus is often experienced after the age of 50 years but children and young adults can also experience it once in a while. Persistent tinnitus can lead to depression, anxiety, irritability, and difficulty in concentrating on any work. While there is no particular cure for this, there are ways to manage or reduce its occurrence.

Before we understand the causes, symptoms, diagnosis, treatment, and management of tinnitus, let’s look at the anatomy and how your ear functions.

Your Ears

Your ears not only perform the function of hearing — they are also important for controlling position sense and balance. Each ear is divided into 3 sections: 

a) Outer ear: The external part of your ear consists of the pinna and ear lobe. The pinna is a hard, shell-like part of your external ear, and is made of cartilage (soft, rubbery tissues that provide protection to ends of bones and joints) and skin. The pinna directs sound waves from the external (outside) environment into your external auditory canal (ear canal), which in turn moves the sound waves towards the tympanic membrane (also known as the eardrum). 

b) Middle ear: The middle ear is an air-filled open space that contains 3 tiny bones which are the malleus (hammer), incus and stapes (stirrup). Sound waves that reach your eardrum are made to vibrate here. This vibration is then transmitted, amplified and passed on to the oval window (a thin membrane between the middle and inner ear).

c) Inner ear: The inner ear (also called the labyrinth) contains 2 main structures — the cochlea (or the hearing organ), which is involved in hearing, and the vestibular system which is responsible for maintaining balance.

How Do You Hear Sounds?

Your cochlea is filled with fluid that contains thousands of specialized sensory hair cells with projections called cilia. Tiny waves are formed when vibrations transmitted from your middle ear reach the inner ear fluid, which makes the cilia vibrate. The sensory hair cells then convert these vibrations into nerve impulses, or signals, which are sent to your brain (to the auditory nerve), where they are interpreted as sound.

The auditory nerve is a bundle of nerve fibers that carries hearing information between the cochlea and the brain.

What Causes Tinnitus?

Tinnitus is produced by the stimulation of the hair cells present within your cochlea.

There are many causes of tinnitus.

  • External ear. Accumulation of earwax, dirt, or other foreign materials in your ear canals can become blocked with a buildup of fluid (ear infection). A blockage can change the pressure in your ear, causing tinnitus.

  • Middle ear. Fluid accumulation or infection that either cause blockage or change in pressure in the middle ear. Another factor is otosclerosis, a condition characterized by the abnormal hardening of tissues inside your ear.

  •  Cochlea. The most common factors causing tinnitus relating to the cochlea are: 

    • Age-related degeneration is the gradual, symmetrical degeneration (declining or deterioration) of the cochlea that causes age-related hearing loss and tinnitus.  

    • Noise-Induced Hearing Loss (NIHL) occurs when your cochlea are damaged by loud sounds. Loud noise exposure can also cause tinnitus—a ringing, buzzing, or roaring in your ears or head. 

    • Post-traumatic experiences such as a head, brain or neck injury can cause damage to the cochlea and consequently lead to tinnitus.

    • Spontaneous otoacoustic sound emissions (SOAEs) are sounds that are emitted from the ear without external stimulation and are measurable with sensitive microphones.  

  • Head, neck, or brain tumours (are groups of abnormal cells that form lumps or growths) can cause tinnitus. 

  • Vascular malformations are a result of the abnormal growth and development of a single type of vessel or a combination of vessels (veins). Vascular malformations in your inner ear can cause blood to flow through the veins with greater pressure, causing tinnitus at times.

  • Drug-induced tinnitus. Medications are known to cause tinnitus include nonsteroidal anti-inflammatory drugs (NSAIDs) and certain antibiotics, cancer drugs, water pills (diuretics).

  •  Muscular abnormalities are problems that cause muscle disorders, leading to pain and weakness. Muscular abnormalities can cause several degenerative diseases in your head and neck and lead to tinnitus.

  • Stress, sleep problems, anxiety, or depression – all of this can make your tinnitus worse. 

Besides the above causes, there is an increased risk of tinnitus due to age, gender (more likely in men), smoking, continuous exposure to loud sounds at home or work, alcohol abuse, and certain health conditions such as heart diseases or high blood pressure (hypertension).

Types Of Tinnitus

Tinnitus can be classified as:

  • Temporary tinnitus is one that occurs suddenly, due to- exposure to loud sounds like in a concert or in a manufacturing unit.  

  • Objective tinnitus is the ringing of your ears in the presence of an objective or particular sound source.

  • Subjective tinnitus is the sensation of sounds in the absence of any external stimuli or source. Only you can hear those sounds and others around you do not hear or perceive any sounds.

  • Fluctuant tinnitus is nothing but perceived sensations of sound that keeps fluctuating (comes and goes depending upon exposure to a source of the stimulus).

  • Pulsatile tinnitus is caused by blood circulating in or near your ears. 

  • Frequency tinnitus is hearing high-pitched sounds, based on the frequency of sound such as whistling, the sound of crickets, drumming, etc. 

  • Unilateral and bilateral tinnitus. When you experience tinnitus in both ears at the same time, it is known as bilateral tinnitus. Less commonly experienced, unilateral tinnitus develops in only one ear. Unilateral or single-sided tinnitus is usually more serious and requires an immediate check by your ENT specialist.

Symptoms of Tinnitus

  • Hearing loss

  • Fatigue

  • Stress

  • Sleep problems

  • Decreased productivity at work

  • Trouble concentrating

  • Depression and anxiety

  • Irritability

  • Headaches

Diagnosis of Tinnitus

Though largely self-limiting and benign (not harmful), basic diagnostic tests include:

  • Audiograms are used to diagnose and monitor the hearing loss. It is a graph that shows the softest sounds a person can hear at different pitches or frequencies. 

  • Hearing (audiological) exam. In this test, you are required to sit in a soundproof room, wearing earphones that transmit specific sounds into one ear at a time. You'll indicate when you can hear the sound, and your results will be compared with results considered normal for your age. This can help rule out or identify possible causes of tinnitus.

  •  Tinnitus matching is conducted to find a match in pitch between tinnitus and a sound. You are required to identify a sound that is most similar or closest to your perception of your tinnitus sounds to identify the cause.

  •  Impedance audiometry is a way to measure the pressure in your middle ear and monitor the tension in your eardrum. While impedance audiometry does not provide any specific information about tinnitus, it is a useful diagnostic tool to identify various types of dysfunctions in your ear. 

  • MRI (Magnetic Resonance Imaging) done to look for vascular causes of tinnitus or the presence of any tumours in your ear.

Treatment of Tinnitus

There is no particular treatment for tinnitus. The first step to treat tinnitus is to identify the underlying cause of tinnitus and treat it. There are certain things you can do to manage tinnitus with lifestyle modifications.

Management of Tinnitus

  • Avoid exposure to- loud sounds from external sources.  

  • Medications such as low doses of anti-anxiety drugs help reduce tinnitus. These should be taken on the advice of your doctor.

  • Sound enrichment uses therapeutic sounds to provide relief from tinnitus and/or decreased sound tolerance, such as white noise, soothing tones/music, and natural sounds.

  • TRT (Tinnitus retraining therapy) is done to remove the negative connotation that the mind has with the disturbing sound of tinnitus.

  • Use a hearing aid and tinnitus masker if you have an associated hearing loss. A tinnitus masker is an electronic hearing aid device that generates noise at low levels, designed to mask (hide) the presence of tinnitus.

A few lifestyle modifications can also help manage tinnitus. It is advisable to listen to music at moderate volumes while using your earphones or headphones. Use earplugs and mufflers to protect your ears when in noisy environments.

Usually, in most people, tinnitus improves with treatment of the underlying cause. Your doctor would suggest treatments that reduce or mask the noise, making tinnitus less noticeable. Consult your doctor to know more about ways to manage tinnitus.

Disclaimer: This article is written by the Practitioner for informational and educational purposes only. The content presented on this page should not be considered as a substitute for medical expertise. Please "DO NOT SELF-MEDICATE" and seek professional help regarding any health conditions or concerns. Practo will not be responsible for any act or omission arising from the interpretation of the content present on this page.